This is the preview version of the Wisconsin State Legislature site.
Please see http://docs.legis.wisconsin.gov for the production version.
LRB-1538/1
MED&TJD:emw&jm
2017 - 2018 LEGISLATURE
October 27, 2017 - Introduced by Senators LeMahieu, Vukmir, Harsdorf, Nass,
Moulton, Marklein, Olsen and Ringhand, cosponsored by Representatives
Rohrkaste, Jagler, Kooyenga, Kitchens, Petersen, Tranel, Spiros, Tusler,
Hutton, Horlacher, Neylon, Tittl, Berceau, Genrich, Anderson, Subeck,
Sinicki, Kuglitsch, Hintz and Wichgers. Referred to Committee on Health
and Human Services.
SB497,2,13 1An Act to repeal 50.01 (1b), 77.54 (14) (f) 3., 118.2925 (1) (b), 146.89 (1) (r) 3.,
2252.01 (1c), 440.03 (13) (b) 3., 440.03 (13) (b) 42., 440.08 (2) (a) 4m., 440.08 (2)
3(a) 50., 441.11 (title), 441.11 (1), 441.11 (3), 441.15, 441.16, 448.035 (1) (a) and
4450.01 (1m); to renumber and amend 253.13 (1), 255.06 (1) (d), 441.06 (7) and
5441.11 (2); to amend 29.193 (1m) (a) 2. (intro.), 29.193 (2) (b) 2., 29.193 (2) (c)
63., 29.193 (2) (cd) 2. b., 29.193 (2) (cd) 2. c., 29.193 (2) (e), 29.193 (3) (a), 45.40
7(1g) (a), 46.03 (44), 50.08 (2), 50.09 (1) (a) (intro.), 50.09 (1) (f) 1., 50.09 (1) (h),
850.09 (1) (k), 50.49 (1) (b) (intro.), 51.41 (1d) (b) 4., 70.47 (8) (intro.), 77.54 (14)
9(f) 4., 97.59, 102.13 (1) (a), 102.13 (1) (b) (intro.), 1., 3. and 4., 102.13 (1) (d) 1.,
102., 3. and 4., 102.13 (2) (a), 102.13 (2) (b), 102.17 (1) (d) 1. and 2., 102.29 (3),
11102.42 (2) (a), 106.30 (1), 118.15 (3) (a), 118.29 (1) (e), 118.2925 (3), 118.2925 (4)
12(c), 118.2925 (5), 146.343 (1) (c), 146.82 (3) (a), 146.89 (1) (r) 1., 146.89 (1) (r) 8.,
13146.89 (6), 252.07 (8) (a) 2., 252.07 (9) (c), 252.10 (7), 252.11 (2), (4), (5), (7) and
14(10), 252.15 (3m) (d) 11. b. and 13., (5g) (c), (5m) (d) 2. and (e) 2. and 3. and (7m)

1(intro.) and (b), 252.16 (3) (c) (intro.), 252.17 (3) (c) (intro.), 253.07 (4) (d),
2253.115 (4), 253.115 (7) (a) (intro.), 253.15 (2), 255.06 (2) (d), 255.07 (1) (d),
3257.01 (5) (a) and (b), 341.14 (1a), (1e) (a), (1m) and (1q), 343.16 (5) (a), 343.51
4(1), 343.62 (4) (a) 4., 440.981 (1), 440.982 (1), 440.987 (2), 441.01 (7) (a) (intro.)
5and 1., 441.01 (7) (b), 441.06 (3), 441.07 (1g) (intro.), (a), (c) and (e), 441.18 (2)
6(a) (intro.), 441.18 (2) (b), 441.18 (3), 448.03 (2) (a), 448.035 (2), (3) and (4),
7448.56 (1) and (1m) (b), 448.67 (2), 448.956 (1m), 450.01 (16) (h) 2., 450.01 (16)
8(hr) 2., 450.03 (1) (e), 450.11 (1i) (a) 1., 450.11 (1i) (b) 2. b., 450.11 (7) (b), 450.11
9(8) (e), 450.13 (5) (b), 462.04, 655.001 (7t), 655.001 (9), 655.005 (2) (a), 961.01
10(19) (a) and 961.395; and to create 253.115 (1) (f), 253.13 (1) (a), 253.15 (1) (em),
11255.06 (1) (f) 2., 440.03 (13) (b) 39m., 440.08 (2) (a) 47. and 441.09 of the statutes;
12relating to: advanced practice registered nurses and granting rule-making
13authority.
Analysis by the Legislative Reference Bureau
Nursing practice and licensure
This bill makes various changes to practice, licensure, and certification
requirements for nurses, which are administered by the Board of Nursing.
Licensure of advanced practice registered nurses
Under current law, a person who wishes to practice professional nursing must
be licensed by the Board of Nursing as a registered nurse (RN). This bill creates an
additional system of licensure for advanced practice registered nurses (APRNs), to
be administered by the board. Under the bill, in order to apply for an APRN license,
a person must 1) hold, or concurrently apply for, an RN license, 2) have completed
an accredited graduate-level or postgraduate-level education program preparing
the person to practice as an APRN in one of four recognized roles, and 3) pay a fee
set by the Department of Safety and Professional Services. The bill also allows a
person who has not completed an accredited education program described above to
receive an APRN license if the person 1) on January 1, 2017, was both licensed as an
RN in Wisconsin and practicing in one of the four recognized roles and 2) satisfies
additional practice or education criteria established by the board. The four
recognized roles, as defined in the bill, are 1) certified nurse-midwife, 2) certified
registered nurse anesthetist, 3) clinical nurse specialist, and 4) nurse practitioner.

The bill also requires the board, upon granting a person an APRN license, to also
grant the person one or more endorsements corresponding to the recognized role or
roles for which the person qualifies. The holder of an APRN license may append the
title “A.P.R.N." to his or her name, as well as a title corresponding to whichever
endorsements that the person possesses.
The bill prohibits any person from using the title “A.P.R.N.," and from otherwise
indicating that he or she is an APRN, unless the person is licensed by the board as
an APRN. The bill also prohibits the use of titles and abbreviations corresponding
to a recognized role unless the person has an endorsement for that role. Under the
bill, when an APRN renews his or her APRN license, the board must grant the person
the renewal of both the person's RN license and the person's APRN license. The bill
requires an APRN to complete continuing education requirements in clinical
pharmacology or therapeutics relevant to the APRN's area of practice, including a
minimum number of hours regarding best practices in prescribing controlled
substances. The bill also requires an APRN, when applying for a license or license
renewal or upon request of the board, to submit to the board evidence that he or she
has in effect malpractice liability insurance coverage in the minimum amounts
required by the rules of the board.
Practice of nurse-midwifery
This bill repeals licensure and practice requirements specific to
nurse-midwives and the practice of nurse-midwifery, including specific
requirements to practice with an obstetrician and maintain malpractice insurance.
Under the bill, “certified nurse-midwife" is one of the four recognized roles for
APRNs, and a person who practices nurse-midwifery under current law who
satisfies the APRN licensure requirements may apply for and receive an APRN
license and a certified nurse-midwife endorsement, except that the bill also requires
that a person applying for a certified nurse-midwife endorsement be certified by the
American Midwifery Certification Board. In addition, the bill prohibits the practice
of nurse-midwifery, as defined under current law, without a certified nurse-midwife
endorsement.
Advanced practice registered nurse prescribers
Under current law, a person licensed as an RN may apply to the board for a
certificate to issue prescription orders if the person meets certain requirements
established by the board. A person holding the certificate is subject to various
practice requirements established by the board and must possess malpractice
liability insurance in an amount determined by the board.
The bill eliminates certificates to issue prescription orders and instead provides
that the board may grant an APRN who applies for licensure and who meets the
education, training, and examination requirements established by the board the
authority to issue prescription orders. The bill requires the board to maintain a
register of all APRNs who are authorized to issue prescription orders.
Other changes
The bill makes numerous other changes throughout the statutes relating to
APRNs and APRN prescribers, including changing references to “advanced practice
nurse" and “advanced practice nurse prescriber" in favor of the terms “advanced

practice registered nurse" and “advanced practice registered nurse who has
prescribing authority."
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB497,1 1Section 1. 29.193 (1m) (a) 2. (intro.) of the statutes is amended to read:
SB497,4,62 29.193 (1m) (a) 2. (intro.) Has a permanent substantial loss of function in one
3or both arms or one or both hands and fails to meet the minimum standards of any
4one of the following standard tests, administered under the direction of a licensed
5physician, a licensed physician assistant, a licensed chiropractor, or a certified
6licensed advanced practice registered nurse prescriber:
SB497,2 7Section 2. 29.193 (2) (b) 2. of the statutes is amended to read:
SB497,4,138 29.193 (2) (b) 2. An applicant shall submit an application on a form prepared
9and furnished by the department, which shall include a written statement or report
10prepared and signed by a licensed physician, a licensed physician assistant, a
11licensed chiropractor, a licensed podiatrist, or a certified licensed advanced practice
12registered nurse prescriber prepared no more than 6 months preceding the
13application and verifying that the applicant is physically disabled.
SB497,3 14Section 3. 29.193 (2) (c) 3. of the statutes is amended to read:
SB497,5,715 29.193 (2) (c) 3. The department may issue a Class B permit to an applicant
16who is ineligible for a permit under subd. 1., 2. or 2m. or who is denied a permit under
17subd. 1., 2. or 2m. if, upon review and after considering the physical condition of the
18applicant and the recommendation of a licensed physician, a licensed physician
19assistant, a licensed chiropractor, a licensed podiatrist, or a certified licensed

1advanced practice registered nurse prescriber selected by the applicant from a list
2of licensed physicians, licensed physician assistants, licensed chiropractors, licensed
3podiatrists, and certified licensed advanced practice nurse prescribers registered
4nurses
compiled by the department, the department finds that issuance of a permit
5complies with the intent of this subsection. The use of this review procedure is
6discretionary with the department and all costs of the review procedure shall be paid
7by the applicant.
SB497,4 8Section 4. 29.193 (2) (cd) 2. b. of the statutes is amended to read:
SB497,5,149 29.193 (2) (cd) 2. b. The person has a permanent substantial loss of function
10in one or both arms and fails to meet the minimum standards of the standard upper
11extremity pinch test, the standard grip test, or the standard nine-hole peg test,
12administered under the direction of a licensed physician, a licensed physician
13assistant, a licensed chiropractor, or a certified licensed advanced practice registered
14nurse prescriber.
SB497,5 15Section 5. 29.193 (2) (cd) 2. c. of the statutes is amended to read:
SB497,5,2016 29.193 (2) (cd) 2. c. The person has a permanent substantial loss of function in
17one or both shoulders and fails to meet the minimum standards of the standard
18shoulder strength test, administered under the direction of a licensed physician, a
19licensed physician assistant, a licensed chiropractor, or a certified licensed advanced
20practice registered nurse prescriber.
SB497,6 21Section 6. 29.193 (2) (e) of the statutes is amended to read:
SB497,6,622 29.193 (2) (e) Review of decisions. An applicant denied a permit under this
23subsection, except a permit under par. (c) 3., may obtain a review of that decision by
24a licensed physician, a licensed physician assistant, a licensed chiropractor, a
25licensed podiatrist, or a certified licensed advanced practice registered nurse

1prescriber designated by the department and with an office located in the
2department district in which the applicant resides. The department shall pay for the
3cost of a review under this paragraph unless the denied application on its face fails
4to meet the standards set forth in par. (c) 1. or 2. A review under this paragraph is
5the only method of review of a decision to deny a permit under this subsection and
6is not subject to further review under ch. 227.
SB497,7 7Section 7. 29.193 (3) (a) of the statutes is amended to read:
SB497,6,118 29.193 (3) (a) Produces a certificate from a licensed physician, a licensed
9physician assistant, a licensed optometrist, or a certified licensed advanced practice
10registered nurse prescriber stating that his or her sight is impaired to the degree that
11he or she cannot read ordinary newspaper print with or without corrective glasses.
SB497,8 12Section 8. 45.40 (1g) (a) of the statutes is amended to read:
SB497,6,1713 45.40 (1g) (a) “Health care provider" means an advanced practice registered
14nurse prescriber certified under s. 441.16 (2) licensed under ch. 441, an audiologist
15licensed under ch. 459, a dentist licensed under ch. 447, an optometrist licensed
16under ch. 449, a physician licensed under s. 448.02, or a podiatrist licensed under s.
17448.63.
SB497,9 18Section 9. 46.03 (44) of the statutes is amended to read:
SB497,7,219 46.03 (44) Sexually transmitted disease treatment information. Prepare and
20keep current an information sheet to be distributed to a patient by a physician,
21physician assistant, or certified advanced practice registered nurse prescriber who
22has prescribing authority under s. 441.09 (2) (c)
providing expedited partner therapy
23to that patient under s. 448.035. The information sheet shall include information
24about sexually transmitted diseases and their treatment and about the risk of drug
25allergies. The information sheet shall also include a statement advising a person

1with questions about the information to contact his or her physician, pharmacist, or
2local health department, as defined in s. 250.01 (4).
SB497,10 3Section 10. 50.01 (1b) of the statutes is repealed.
SB497,11 4Section 11. 50.08 (2) of the statutes is amended to read:
SB497,7,105 50.08 (2) A physician, an advanced practice registered nurse prescriber
6certified under s. 441.16 (2) who has prescribing authority under s. 441.09 (2) (c), or
7a physician assistant licensed under ch. 448, who prescribes a psychotropic
8medication to a nursing home resident who has degenerative brain disorder shall
9notify the nursing home if the prescribed medication has a boxed warning under 21
10CFR 201.57
.
SB497,12 11Section 12. 50.09 (1) (a) (intro.) of the statutes is amended to read:
SB497,7,1912 50.09 (1) (a) (intro.) Private and unrestricted communications with the
13resident's family, physician, physician assistant, advanced practice registered nurse
14prescriber, attorney, and any other person, unless medically contraindicated as
15documented by the resident's physician, physician assistant, or advanced practice
16registered nurse prescriber in the resident's medical record, except that
17communications with public officials or with the resident's attorney shall not be
18restricted in any event. The right to private and unrestricted communications shall
19include, but is not limited to, the right to:
SB497,13 20Section 13. 50.09 (1) (f) 1. of the statutes is amended to read:
SB497,7,2521 50.09 (1) (f) 1. Privacy for visits by spouse or domestic partner. If both spouses
22or both domestic partners under ch.770 are residents of the same facility, the spouses
23or domestic partners shall be permitted to share a room unless medically
24contraindicated as documented by the resident's physician, physician assistant, or
25advanced practice registered nurse prescriber in the resident's medical record.
SB497,14
1Section 14. 50.09 (1) (h) of the statutes is amended to read:
SB497,8,52 50.09 (1) (h) Meet with, and participate in activities of social, religious, and
3community groups at the resident's discretion, unless medically contraindicated as
4documented by the resident's physician, physician assistant, or advanced practice
5registered nurse prescriber in the resident's medical record.
Loading...
Loading...